Containing an Outbreak of Carbapenem-Resistant Acinetobacter baumannii in a COVID-19 Isolation Unit

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Investigators in Seoul, South Korea, successfully contained an outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) in a COVID-19 isolation ward by employing enhanced environmental cleaning and adding additional gowning and gloving protocol.

Clinicians caring for patients with COVID-19 are always concerned about the development of multidrug-resistant infections, which can complicate patient cases. CRAB, in particular, is a problematic nosocomial pathogen that is difficult to eradicate because of its ability to survive for long periods of time on dry surfaces and its resistance to common disinfectants.

In a poster presented at IDWeek 2022, held October 19-23, 2022, in Washington, DC, investigators detailed the action taken after the index case of CRAB infection was detected in an 85-year-old female patient with COVID-19 who was referred to a tertiary South Korean hospital from a long-term care facility in October 2021.

A total of 23 patients with COVID-19 and CRAB were reported during the outbreak period. Fourteen (60.9%) were male and the mean patient age was 72.9 years (+ 13.8). Of the initial specimens collected, CRAB was identified in the sputum of 21 patients (91.3%), in the blood of 6 patients (26.1%), in the urine of 1 patient (4.3%), and in the skin swab of 1 patient (4.3%). The average duration from admission to CRAB isolation was 13.3 days (+ 11.0), and a majority (18, 78.3%) of patients were applying high-flow nasal cannula or ventilation. The most common underlying comorbidities at baseline included hypertension, diabetes mellitus, and cardiovascular disease (16/69.6%, 10/43.5%, and 8/34.8%, respectively).

Investigators determined via environmental culture that the CRAB outbreak occurred mainly around the index case, as the phenotypic antimicrobial resistance patterns of the isolates collected from patients and from the environment were identical.

“We applied the environmental cleaning using sodium hypochlorite (NaClO) 1000 ppm and phenolic compounds more than twice a day, enhanced hand hygiene, and additional gowning and gloving over personal protective equipment (PPE) mandatory for COVID-19 on 29th October,” investigators reported. “No additional CRAB cases occurred since 2nd November 2021 for 2 weeks.”

The team concluded that it is helpful to employ additional contact precautions and environmental cleaning in COVID-19 isolation wards alongside regular COVID-19 precautions, such as personal protective equipment, in order to prevent multidrug-resistant infections.